International Specialists Conference on Ear, Nose and Throat Disorders November 07-08, 2016 Alicante, Spain

Biography:

Abstract:

Background: Although communication disorder among the Moroccan population is prevalent, information readily available on this issue is scarce. National statistical information is the official authority that estimates the magnitude of this disorder. With the help of an online survey among the Speech-Language therapist (SLT) in 15 major cities of the kingdom of Morocco, the present study aims at estimating the prevalence of communication disorders among Moroccan population. The study is particularly keen in estimating the factors like age of the affected population and the tools the language therapists are using in addressing the issue. On analysing the data, the study concludes with the outcome that speech disorders are top in the list of communication disorders and there must be early screening in detecting the issue to treat it effectively. The study also feels the need to apply appropriate tools in addressing the issue that suits the socio-cultural context of Morocco

Material and Methods: A questionnaire based online survey was conducted among a fairly representative

sample of Speech-Language therapist (SLT) covering 15 major cities of the kingdom of Morocco.

Results: The questionnaires were completed by 68SLTs. Within the studied sample, 53.8% show oral communication disorders; 16.7% have written communication disorders, 11.2% show disabilities (deafness, autism, mental disability and other Rare Diseases), 10.5% have Ear-Nose-Throat (ENT) disorders, and the rest (7.8%) has neurological disorders. It is estimated that 5.62% of the Moroccan population are affected with speech disorders, 1.74% are unable to communicate in writing, 1.17% are disabled, 1.09% are affected with ENT disorders, and 0.81% have neurological disorders. Thus, in this study, we found that the estimated prevalence of communication disorders were 10.43% for overall the population, among them speech disorder found to be very prominent.

Conclusion: In the selected sample, we found that oral language disorders are more prevalent than the other kinds of communication disorders. And the prevalence of delayed language is higher than the other kinds of oral language disorders.

Biography:

MSc Public Health - Health Services Management stream - LSHTM, UCL, London 2011-2013

MSc Health &Development, IHMT, UNL, Lisbon 2006 - 2009

Senior Consultant Anaesthesiology (2005-2010) Lisbon, Portugal (H. STa Maria)

Specialty Doctor / Locum Specialist (2010-2013) London, UK (2010- 2013)

International Health- Health & Development PhD program (2013- current)

Abstract:

Surgical waiting time remains an important issue regarding access to health care provision. It is considered to be excessive in most OEDC countries (over twelve weeks or ninety days). The development of day surgery has been one of the strategies that proved effective in reducing surgical waiting time. This study aims to establish a correlation between surgical waiting time and the percentage of day-surgery cases, in hospitals with surgical services, in the Portuguese National Health Services. Methodology: An observational was conducted to establish the correlations existing between surgical waiting time and the percentage of day-surgery procedures realized, as well as associations with other variables, through multivariate and correlation analysis. Data was obtained at the Ministry of Health (ACSS).Results: A negative, statistically significant Spearman’s correlation was observed between the percentage of day-surgery cases and the waiting surgical time for elective procedures.

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Mariyah Selmi is a 3 foundation trainee with a keen interest in quality improvement and patient safety.

Abstract:

Background: Surgical ward rounds are generally fast paced. With a quick patient turn over, key information regarding pre/postoperative care as well as nutrition status often gets missed. Documentation is routinely done by ward based F1 doctors who have had little involvement in management. If seniors are unavailable, omissions in documentation can lead to detrimental outcomes for the patients, such as unnecessary antibiotics/dietary restrictions. The  patients’ notes provide a record of on-going clinical issues and serve as a medico-legal document. Therefore, the need for notes to be thorough and legible with a clear indication to all MDT members regarding future care is paramount.
Aim: Aim of this study is to quantify the information documented during ward rounds across the general surgical wards and its effect on patient care.
Method: The last ward round entry in the patients notes was analyzed against 12 parameters chosen by MDT members. This included medicolegal aspects: Dates and time, patient identifier, signature with GMC number of doctor, discussion with patient noted and overall legibility; as well as patient review aspects: Current issues, working diagnosis, plan based on current condition, medication review, dietary requirement review and estimated discharge date with follow up instructions.
Results: A total of 47 entries were analyzed, medico-legal aspects of documentation were above 79%. Medication and diet were only reviewed in 36% of cases with clinical details only being explained to the patients in 6% of cases. Conclusion: Lack of clear documentation may have led to poor patient outcomes and difficulty for other team members to provide care. The introduction of a new pro-forma prompting daily review of the key areas has shown a vast improvement in documentation and communication between staff and patients. Questioning and reviewing these areas has also provided a learning opportunity with positive feedback from junior doctors.

Biography:

Bushra Mukhtar Alhajjaji has completed her Bachelor’s degree of General Medicine and Surgery from King Abdulaziz University. She is doing training at the King Abdulaziz University Hospital of Surgery.

Abstract:

Background & Objectives: Peripheral artery disease is considered as one of the highly prevalent public health issues, associated with major detrimental effects on quality of life and functional status; it is also the main cause of limb  amputation. When involving the carotid arteries, leading to carotid artery stenosis, makes it considered as a strong predictor of strokes and even death. Peripheral artery disease and abdominal aortic aneurysms have many risk  factors in common. Thus, our aim in this hospital based study is establishing the prevalence and demographic risk factors for each of the previously mention disorders individually, following that, we want to assess the association between them, and finally to evaluate if screening these patients who have one of the three conditions for the other two would be beneficial as a preventive measure.
Methods: This is a prospective cross-sectional study. In which PAD, CAS and AAA were screened in 34 susceptible patients in KAUH clinics, for screening we used simple non-invasive procedures ankle brachial index, carotid Doppler ultrasound, and abdominal aortic ultrasound.
Results: ABI study showed 41.2% of patients have PAD, of which 50% of them had bilateral PAD and only 7.14% were asymptomatic. The majority of patients were classified into moderate to severe stages of the disease. The incidence of CAS in PAD patients turned out to be 21.4% with increase in severity of CAS, while the incidence of AAA in PAD patients was 7.14%. Diabetes mellitus was reported as the most significant risk factor of PAD and CAS.
Conclusions: The prevalence of CAS was markedly higher in PAD patients. These results showing a high risk of cerebral and carotid artery lesions in patients with PAD, suggest that screening for CAS is important for treatment, rehabilitation and prevention in these patients. Further studies are needed to determine the exact prevalence and risk factors for PAD and to evaluate the relation between CAS and AAA in PAD patients in a larger sample group in different facilities in Saudi Arabia.

Biography:

M Tayyar Kalcioglu has graduated from Medical faculty of Hacettepe University and worked as an ENT Resident in Inonu University, Department of Otorhinolaryngology, Turkey. He became an Associate Professor and Professor in Inonu University and has been working in Istanbul Medeniyet University since 2012. He has published more than 25 papers in reputed journals and has been serving as an Editorial Board Member of repute.

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Objective: The aim of that experimental study was to investigate the possible neurotoxic effects of the bone cement (BC) on the facial nerve with the electrophysiological and histological examinations.
Materials & Methods: Twenty male Wistar albino rats; divided into 4 groups were used in the study. Group A was determined as a control group and the group B as a sham. In group C; one drop BC was dropped on facial nerve trunk and washed with saline after waiting 5 seconds. In group D; one drop BC was dropped on facial nerve trunk and the wound was closed primarily after waiting 5 minutes to set BC. Electromyographic measurements (EMG) were performed preoperatively and postoperatively at the fourth week. Animals were euthanized after applying EMG at the fourth week, facial nerve tissue and environmental samples were taken for the histopathological examination.
Results: When the EMG wave parameters evaluated in four groups, there was a statistically significant decrease of the postoperative amplitude levels compared with preoperative amplitude levels in Group D (p<0.05, p=0,014). There was no significant difference between the groups in terms of inflammation in histopathological evaluation. Foreign body reaction or granulation tissue was not detected in none of the groups. Conclusion: To the best of our knowledge, that is the first experimental study which investigates the possible neurotoxic effects of the BC on the facial nerve with the electrophysiological and histological examinations. Any facial nerve paralysis or nerve conduction block was not detected in animals by EMG. Opinion of the authors is to show special care to avoid the direct neural contact with BC in the middle ear surgery, if the contact occurs removal of BC would be beneficial by aspiration and washing with saline.

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Professor of Otorhinolaryngology, Istanbul Kemerburgaz University, Medical Park GaziosmanpaÅŸa Hospital, Department of Otorhinolaryngology, 2010 – 2015 Clinical Director of Otorhinolaryngology Department,Turkish Ministery of Health,Haseki Training and Research Hospital,2013 - 2015 Vice President , Education Planning and Coordination Committee ,Haseki Training and Research Hospital, Coordinator,Operating Rooms Service,Haseki Training and Research Hospital, 2013-2015 Member, Infection Control  ommittee,HasekiTraining and Research Hospital, 2012-2015 Member,Clinical Research Financial Support Appraisal Committee,Haseki, 2001 2010 Clinical Chief, Otorhinolaryngology Department, Vakıf Gureba Teaching and Research Hospital, 2000 Associated Professor of Otorhinolaryngology,Hacettepe University Medical Faculty, 1989 - 2000: Chief Intern,Vakıf Gureba Training and Research Hospital

Abstract:

Eustachian tube (ET) is a valve activated by levator and tensor veli palatine muscles and its duty is to equalize the pressure inside the tympanic cavity (TC) with outside pressure. Eustachian tube activation is commonly believed to be a sporadic activity which is initiated by swallowing or yawning action. Although there have been numerous electromyographic (EMG )studies to understand
the synergistic behavior of the two muscles, these studies never revealed the heart beat like periodic activity, reflex like nature and the tight relationship between the two muscle signals in terms of amplitude and delay. In a recent clinical study done on 50+ patients we have discovered extraordinarily periodic behavior of EMG signals of ET muscles alongside a very tight relationship between the two signals. Furthermore, there is strong evidence that the relationship of the EMG signals may indicate health status of ET. The study has been done using an unusual location for picking up ET muscle EMG signals which is being used for the first time. The new signal location enabled us to use commercially available subdermal EMG electrodes submucosally firmly placed at target location and furthermore enabled picking without using any local or topical anesthetics. The signals picked up from patients were all high fidelity signals and this led the discovery of periodic, clock-like synergistic signal pattern observed in all patients. This discovery sheds light into the behavior of tubal muscles which appears to be much more complex then what we used to think. Hopefully this discovery may lead to new understanding of electrical activity of ET and may pave the way for solving ET dysfunction (ETD) problem.

Biography:

Zuraida Z is a Senior Medical Lecturer in the Audiology program, School of Health Sciences, Universiti Sains Malaysia (USM). She has received her Medical degree (MD) from USM in 2002 and Master of Science (Medical Audiology) in 2010 from the same university. She has also been an active Researcher in the field balance and vestibular and has published more than 60 papers including journal, oral, books and proceedings. She is currently developing a virtual vestibular rehabilitation procedure for balance disordered patients.

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Tinnitus is known to unfavorably affect patients’ quality of life. Cognitive impairments such as inadequate concentration and attention have been reported in some tinnitus patients. This preliminary study was performed to determine the memory abilities of tinnitus patients using the N100 and p300 evoked residual potential tests. We recruited seven patients with tinnitus who underwent 6 months treatment with Quranic rhythm (group-1) and Broadband noise (BBN) (group-2). All subjects completed the tasks successfully. Statistical analysis showed no significant difference in 4 groups (preBBN, post BBN, pre Quranic and post Quranic) for both tests (p>0.05). The amplitude of N100 wave targeted stimuli in group-1 showed mild cognitive improvement (8 out of 19 channels improvement) compared to group-2 where there was 7 out of 19 channels. The latency of N100 wave target group-2 showed better improvement than group-1. The amplitude of P300 wave targeted stimuli in group-2 patients with mild cognitive improvement compared to group-1. The latency of p300 wave targeted stimuli in group-1 and 2 showed equal improvements after intervention. Our findings suggest that Quranic rhythm is one of the alternatives and a potentially new treatment option for tinnitus patients in addition to the use of Broadband noise.

Biography:

Susanna Simberg is a Speech Language Pathologist and Professor of Logopedics at Åbo Akademi University and University of Oslo, Norway. She has been doing
research on occupational voice disorders and exploring the rationale on voice therapy methods in the clinic.

Abstract:

Voice disorders are common but most available methods for therapeutic treatment and are not fully scientifically explored. Phonation into glass tubes, keeping the free end of the tube in water, has been a frequently used voice therapy method in Finland since the 1960s, and more recently also in other countries. This method is used in voice therapy for different groups of patients, such as patients with functional voice disorders, vocal nodules and patient suffers from incomplete vocal fold closure, for example due to recurrent laryngeal nerve paresis. Earlier results have suggested that the method affects the vocal apparatus in various ways. It has been proposed that the training alters vocal fold vibratory patterns, collision threshold pressure and the vertical position of the larynx. The method also increases and modulates the intraoral pressure, and both the magnitudes of the pressure variations as well as the average pressure increase are directly related to the water depth. This workshop consists of two parts (45+30 min). The first part gives a clinical demonstration of the resonance tube method and presents some examples on how it can be used in various ways depending on the kind of voice disorder and the aims of the therapy. The second part will give an overview of previous results and on-going research on the method, enabling the participants to interpret the rationale of this voice therapy method with regards to current knowledge. 10 participants can take active part in the workshop, while 30 can be in the audience.

Biography:

Greta Wistbacka is a Speech Language Pathologist and pursuing her PhD in Logopedics at Åbo Akademi University in collaboration with the Karolinska Institutet in Stockholm, Sweden. The focus of her research is on “The use of semi-occluded vocal tract exercises in voice therapy”.

Abstract:

Voice disorders are common but most available methods for therapeutic treatment and are not fully scientifically explored. Phonation into glass tubes, keeping the free end of the tube in water, has been a frequently used voice therapy method in Finland since the 1960s, and more recently also in other countries. This method is used in voice therapy for different groups of patients, such as patients with functional voice disorders, vocal nodules and patient suffers from incomplete vocal fold closure, for example due to recurrent laryngeal nerve paresis. Earlier results have suggested that the method affects the vocal apparatus in various ways. It has been proposed that the training alters vocal fold vibratory patterns, collision threshold pressure and the vertical position of the larynx. The method also increases and modulates the intraoral pressure, and both the magnitudes of the pressure variations as well as the average pressure increase are directly related to the water depth. This workshop consists of two parts (45+30 min). The first part gives a clinical demonstration of the resonance tube method and presents some examples on how it can be used in various ways depending on the kind of voice disorder and the aims of the therapy. The second part will give an overview of previous results and on-going research on the method, enabling the participants to interpret the rationale of this voice therapy method with regards to current knowledge. 10 participants can take active part in the workshop, while 30 can be in the audience.

Biography:

Zuraida Z is a Senior Medical Lecturer in the Audiology program, School of Health Sciences, Universiti Sains Malaysia (USM). She has received her Medical degree (MD) from USM in 2002 and Master of Science (Medical Audiology) in 2010 from the same university. She has also been an active Researcher in the field balance and vestibular and has published more than 60 papers including journal, oral, books and proceedings. She is currently developing a virtual vestibular rehabilitation procedure for balance disordered patients.

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Kelsey Hinther completed her Bachelor of Science in 2013 from University of Saskatchewan. She is currently a fourth year medical student at the University of Saskatchewan. She has a profound interest in research and would like to continue to be involved in research in her future career.

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Laryngeal chondrosarcomas are rare, slow-growing, cartilaginous tumors. Dedifferentiated chondrosarcomas, a rare entity of chondrosarcoma, are more aggressive and associated with a more ominous prognosis. They commonly arise in the hyaline cartilage of the cricoid. Definite diagnosis can be established by incisional biopsy and histopathologic examination. Histopathologic examination reveals a cartilaginous tumor with a malignant spindle cell component. Definitive treatment of dedifferentiated chondrosarcomas of the larynx is total laryngectomy.  We present a case of dedifferentiated chondrosarcoma arising in the cricoid cartilage of a male patient, who presented with 3-week history of dyspnea, stridor, dysphonia and intermittent aphonia. As a result, he underwent a total laryngectomy, and received adjuvant radiation therapy

Biography:

LUIZ ROBERTO MEDINA DOS SANTOS, MD, PhD,  has completed his graduation at the age of 25 years from University of  São Paulo Medical School and his PhD studies from the same University of  São Paulo Medical School, in 2005. He is the chairman of Department of Head and Neck Surgery, Complexo Hospitalar do CEPON – Florianopolis – SC - Brazil and Supervisor for the Head and Neck Surgery Residency Program, Complexo Hospitalar do CEPON – Florianopolis – SC. He has published more than 40 papers in reputed journals and has been serving as an editorial board member of repute.     
 

Abstract:

BACKGROUND: The incidence of thyroid cancer has been increasing in recent years. The extent of thyroidectomy to treat these patients has been largely discussed. In addition, the study of multifocality of thyroid cancer becomes important, especially due to the inconsistency in the literature on related factors, such as recurrence, metastasis and prognosis. The purpose of this study is to describe and analyze the epidemiological and histological factors associated with multicentric thyroid carcinoma.

METHOD: Cross-sectional, retrospective study collecting histological data from total thyroidectomy,  performed in thyroid cancer patients, in a cancer reference center, between January 2013 and December 2014.

RESULTS: 88 patients with histological diagnosis of thyroid cancer were recruited. Females accounted for 87.5% of cases, with mean age of 47.6 years old. Papillary carcinoma was diagnosed in 88% of patients. 65.8% of cases had tumor size less than 2 cm, most of them non encapsulated (58%). One out of three patients had more than one focus of thyroid cancer. Lymph node metastases were reported in 20% of patients. The presence of goiter in the specimen and non encapsulated tumors were significantly associated with multifocal thyroid cancer.

CONCLUSIONS: Two or more thyroid cancer foci were reported in 33% of patients and were significantly associated with the absence of capsule around thyroid tumors (68.9%, n=20, p=0.04) and the presence of goiter (65.5%, n=19, p=0.01). The presence of tumor in the opposite lobe was identified in 24% of patients, in our series.

Biography:

Clinical Director of Otorhinolaryngology Department,Turkish Ministery of Health,Haseki Training and Research Hospital,2010 – 2015. Vice President ,Education Planning and Coordination Committee ,Haseki Training and Research Hospital, 2013 - 2015, Coordinator,Operating  Rooms Service,Haseki Training and Research Hospital Member, Infection Control  Committee,HasekiTraining and Research Hospital

Clinical Chief,Otorhinolaryngology Department, Vakıf Gureba Teaching and Research Hospital,2001 2010 .      

                   Associated Professor of Otorhinolaryngology,Hacettepe University Medical Faculty in 2000,  Chief Intern,Vakıf Gureba Training and Research Hospital in the year 1989 - 2000.

Abstract:

Eustachian tube (ET) is a valve activated by levator and tensor veli palatine muscles and its duty is to equalize the pressure inside the tympanic cavity (TC) with outside pressure. Eustachian tube activation is commonly believed to be a sporadic activity which is initiated by swallowing or yawning action. Although there have been numerous  electromyographic  (EMG )studies to understand the synergistic behavior of the two muscles, these studies never revealed the heart beat like periodic activity, reflex like nature and the tight relationship between the two muscle signals in terms of amplitude and delay. In a recent clinical study done on 50+ patients we have discovered extraordinarily periodic behavior of EMG signals of ET muscles alongside a very tight relationship between the two signals. Furthermore there is strong evidence that the relationship of the EMG signals may indicate health status of ET. The study has been done using an unusual location for picking up ET muscle EMG signals which is being used for the first time. The new signal location enabled us to use commercially available subdermal EMG electrodes submucosally  firmly placed at target location and furthermore enabled picking without using any local or topical anesthetics. The signals picked up from patients were all high fidelity signals and this led the discovery of periodic, clock-like synergistic signal pattern observed in all patients. This discovery sheds light into the behavior of tubal muscles which appears to be much more complex then what we used to think. Hopefully this discovery may lead to new understanding of electrical activity of ET and may pave the way for solving ET dysfunction (ETD) problem.

Biography:

Hossein Talebi has completed his PhD at the age of 32 years from University of Social and Rehabilitation Sciences. He is the head of audiology department in Isfahan University of Medical Sciences. His research line is rehabilitation of inner ear impairments. Now, he is researching and studying the diagnosis and rehabilitation of auditory perception difficulties of children with hearing loss. In order to diagnosing and monitoring of rehabilitation, auditory behavioral responses and auditory evoked potentials are used. The results will surely be useful to betterment of auditory treatment processes of children with hearing loss. He has published many articles in the aforementioned research line.

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This clinical trial investigated the ability of concurrent speech segregation in hearing impaired children. The auditory behavioral responses and auditory late responses (ALRs) were compared between test and control groups prior to vowel auditory training and after 3 and 6 months of vowel auditory training to find the effects of bottom-up training on concurrent speech segregation in hearing impaired children. Auditory behavioral responses for 5 vowels and ALRs for double synthetic vowels, with special physical properties, were recorded in a timetable in 30 hearing impaired children (test group = 15 and control group = 15). Identification score and reaction time data showed that the test group was approximately proficient for some vowels (P < .05 for vowels /æ/, /e/, and /u:/) and took less time to process after 6 months of training. N1-P2 amplitude indexing of the vowel change detection and reflecting central auditory speech representation without active client participation has been increased in the test group (P < .05). The present study showed training-related improvements in concurrent speech segregation. This information provided evidence for bottom-up training based on F0, its differences in auditory scene analysis, and neural underpinnings.

Biography:

Natasha Mirza, MD is a professor of Otolaryngology Head and Neck Surgery at the University of Pennsylvani for the last 21 years. She trained at the University of California, Irvine. She is the Director of the Penn Voice and Swallowing Center and has published extensively in reputed journals. She performs translational research in airway stenosis.. She has received multiple awards and grants, including the teaching award and master clinican award at Penn. She is a member of multiple national and international societies and is very active in education of the residents and medical students.  

Abstract:

Objective:Acqui red Subglottic stenosis (SGS) is a pathologic process driven by airway epithelial injury. There is a lack of functional animal models of this condition.  The aims of this study were to (1) develop and (2) validate an animal model (3) identify inflammatory mediators associated with granulation formation and finally to (4) Identify the change in inflammatory profile using pulse steroid therapy.

Methods: Laryngotracheal complexes (LTCs) from C57BL/6 mice were divided into 3 groups: uninjured,  mechanically injured and chemically injured groups.  LTCs were harvested and then transplanted in to the backs of recipient mice. These transplanted LTCs) were harvested at 3 weeks, sectioned and stained with H & E and the lamina propria thickness was measured. PCR was then performed to study the levels of cytokines and a therapeutic intervention with intraperitoneal pulsed steroid injections was performed.  Validation of this mouse model was performed by studying the granulation tissue from human samples and similarly measuring the cytokines levels.

Results: A significant increase in the lamina propria was observed with formation of granulation tissue at week 3. Inflammatory mediators in the mechanical and chemical trauma groups showed that the levels of TGF beta, IL-1 and MMP9 were elevated. Validation of this animal model was achieved by examining tissue specimens taken from 10 patients with subglottic stenosis. Using PCR the same wound healing markers were elevated in both humans and mice. Finally the use of pulsed intraperitoneal steroid injections resulted in a significant decrease in the cytokines in the treated animals. 

Conclusion: This is a novel, validated animal model to study the development of Subglottic Stenosis.  Chemical and Mechanical Injury mimic pathologic processes and therapeutic interventions in this model allow a better understanding of the processes involved in aberrant wound healing.   

Biography:

Natasha Mirza, MD is a professor of Otolaryngology Head and Neck Surgery at the University of Pennsylvani for the last 21 years. She trained at the University of California, Irvine. She is the Director of the Penn Voice and Swallowing Center and has published extensively in reputed journals. She performs translational research in airway stenosis.. She has received multiple awards and grants, including the teaching award and master clinican award at Penn. She is a member of multiple national and international societies and is very active in education of the residents and medical students.  

Abstract:

Objective: Acquired Subglottic stenosis (SGS) is a pathologic process driven by airway epithelial injury. There is a lack of functional animal models of this condition.  The aims of this study were to (1) develop and (2) validate an animal model (3) identify inflammatory mediators associated with granulation formation and finally to (4) Identify the change in inflammatory profile using pulse steroid therapy.

Methods: Laryngotracheal complexes (LTCs) from C57BL/6 mice were divided into 3 groups: uninjured,  mechanically injured and chemically injured groups.  LTCs were harvested and then transplanted in to the backs of recipient mice. These transplanted LTCs) were harvested at 3 weeks, sectioned and stained with H & E and the lamina propria thickness was measured. PCR was then performed to study the levels of cytokines and a therapeutic intervention with intraperitoneal pulsed steroid injections was performed.  Validation of this mouse model was performed by studying the granulation tissue from human samples and similarly measuring the cytokines levels.

Results: A significant increase in the lamina propria was observed with formation of granulation tissue at week 3. Inflammatory mediators in the mechanical and chemical trauma groups showed that the levels of TGF beta, IL-1 and MMP9 were elevated. Validation of this animal model was achieved by examining tissue specimens taken from 10 patients with subglottic stenosis. Using PCR the same wound healing markers were elevated in both humans and mice. Finally the use of pulsed intraperitoneal steroid injections resulted in a significant decrease in the cytokines in the treated animals. 

Conclusion: This is a novel, validated animal model to study the development of Subglottic Stenosis.  Chemical and Mechanical Injury mimic pathologic processes and therapeutic interventions in this model allow a better understanding of the processes involved in aberrant wound healing.   

Biography:

Natasha Mirza, MD is a professor of Otolaryngology Head and Neck Surgery at the University of Pennsylvani for the last 21 years. She trained at the University of California, Irvine. She is the Director of the Penn Voice and Swallowing Center and has published extensively in reputed journals. She performs translational research in airway stenosis.. She has received multiple awards and grants, including the teaching award and master clinican award at Penn. She is a member of multiple national and international societies and is very active in education of the residents and medical students

Abstract:

Background: First bite syndrome is the reported development of pain in the parotid region during mastication seen after parapharyngeal or deep parotid space surgery. Intraparotid injection of Botulinum Toxin A (BTA) has been suggested as an initial treatment for treatment of this phenomenon but there is little supporting literature to this effect. The purpose of this study is to catalog our experience using this treatment method for first bite syndrome.

Methods: Five patients with first bite syndrome developed after head and neck surgery were treated by multi-site injection of BTA into the parotid gland. Between 17.5 and 50 total units of BTA were injected into 2 or more sites in the parotid region during each procedure. The patients were then subject to follow-up visits every 4 months.

Results:  3 of 5 patients reported a significant improvement in symptoms during the 4 month follow-up visit though complete resolution was not reported. 2 of 5 patients returned for repeat injections for recurrent symptoms up to 1 year from the first injection.

Conclusions: The BTA injection into the affected parotid gland produces a decrease in the severity of symptoms. It is a safe and viable non-invasive treatment for this difficult to treat diagnosis. 

Biography:

Ivica Klapan has completed his postdoctoral studies from Zagreb University School of Medicine/Croatia/EU and PhD research from Zagreb University and  Eye&Ear Institute, Department of Otorhinolaryngology–Head&Neck Surgery/University of Pittsburgh/Pittsburgh/PA/USA, and Division of Head&Neck Oncology&Immunology, and Immunologic Monitoring and Diagnostic Laboratory, Pittsburgh Cancer Institute, University of Pittsburgh/PA/USA. He is the founder/director of Klapan Medical Group University Polyclinic/Zagreb/Croatia/EU. He has published >110 papers: (citations/355; h-index: >20; 14 medical books (7/Croatian and 7/English language/editor/author/co-autor), with >300 lectures/organized by IFOS, EUFOS, ERS, ARS, etc. He is professor of  ORL- Head&Neck Plastic Surgery/School of Medicine/University of Zagreb and Osijek/Croatia/EU. Long-standing member: Collegium Otorhinolaryngologicum Amicitiae Sacrum/CORLAS

Abstract:

Do we need a new sinus surgery technique in a daily routine practice? Imagine that the perception system in humans could be deceived, creating an impression of another „external“ world where we can replace the „true reality“ with the „simulated reality“ that enables precise, safer and faster diagnosis/surgery. Of course, we tried to understand the new, visualized „world of the patient's head“ by creating an impression of virtual perception of the given position of all elements in the patient's head, which does not exist in the real world. This approach was aimed at upgrading diagnostic work-up and endoscopic surgery by ensuring a faster and safer operative procedure, and represent a basis for realistic simulations, and can create an impression of immersion of a physician in a non-existing virtual environment. Every ENT specialist will be able to provide VR support in implementing surgical procedures, with additional correct control of all risks, without additional trauma, while having an impression of the presence in VW, navigating through it and manipulating with virtual objects (3D CA navigation). Furthermore, when the 3D surface with tissues arranged by objects is obtained, it is possible to derive spatial cross-sections at selected cutting planes, thus providing additional insight into the internal regions observed (Osirix/Leap Motion&NES 3D volume rendering models). A tele-presence system extends the operator’s sensory-motor facilities and problem solving abilities to a remote environment, providing the local operator with necessary sensory information to simulate operator’s presence at the remote location (3D surgical planner with remote visualization). Generally speaking, fly-through techniques, which combine the features of endoscopic viewing and cross-sectional volumetric imaging, provide more effective and safer endoscopic procedures (marker-based VR simulation), and use the corresponding cross-sectional image or multiplanar reconstructions to evaluate anatomical structures during the operation (3D navigation and augmented reality in the operating room).

Biography:

Abstract:

Tinnitus is known to unfavorably affect patients quality of life. Cognitive impairments such as inadequate concentration and attention have been reported in some tinnitus patients. This preliminary study was performed to determine the memory abilities of tinnitus patients using the N100 and p300 evoked residual potential tests. We recruited seven patients with tinnitus who underwent 6 months treatment with Quranic rhythm (group 1) and Broadband noise (BBN) (group 2). All subjects completed the tasks successfully. Statistical analysis showed no significant difference in 4 groups (preBBN, post BBN, pre Quranic and post Quranic) for both tests (p>0.05). The amplitude of N100 wave targeted stimuli in group 1 showed mild cognitive improvement (8 out of 19 channels improvement) compared to group 2 where there was 7 out of 19 channels. The latency of N100 wave target group 2 showed better improvement than group 1. The amplitude of P300 wave targeted stimuli in group 2 patients with mild cognitive improvement compared to  group 1. The latency of p300 wave targeted stimuli in group 1 and 2 showed equal improvement after intervention. Our findings suggest that Quranic rhythm is one of the alternatives and a potentially new treatment option for tinnitus patients in addition to the use of Broadband noise.

Biography:

Dr. Levine, a neurologist, was director of the Harvard Medical School Tinnitus Clinic for 25 years before relocating to Israel where he has had a similar position at the Tel Aviv Medical Center.  His work has established the centrality of the muscles of the head and neck in the etiology and treatment of tinnitus.  He has described and successfully treated two hitherto unknown tinnitus syndromes: (A) Typewriter Tinnitus and (B) Somatosensory Pulsatile Tinnitus Syndrome.       

Abstract:

The tinnitus percept can vary in multiple dimensions including: loudness, quality (including pitch), location, temporal pattern, and how it interacts with activation of both the auditory and non-auditory neural systems (e.g. acoustic masking and somatic testing).   From this matrix of possibilities has emerged two pathognomonic tinnitus percepts that have specific (1) etiologies, (2) generating mechanisms, and (3) treatments.   The two pathognomonic tinnitus percepts are as follows:

[A] Clicking (“Typewriter”) Tinnitus:  its percept is pathognomonic (monaural, staccato, irregular, and intermittent); it is caused by auditory nerve distortion usually from vascular compression, that results in ephaptic cross-talk between individual auditory nerve fibers. It can be suppressed by (a) carbamazepine or (b) vascular decompression of the auditory nerve.

[B] Somatosensory Pulsatile Tinnitus Syndrome:  its percept is pathognomonic (cardiac synchronous pulsations that can be abolished by intense head or neck muscle contractions). It is caused by a somatic myofascial dysfunction that leads to abnormal CNS interactions between the somatosensory and auditory systems.  In some cases it can be abolished by  (a) dry needling of head and neck trigger points or (b) auricular electrical stimulation.

A case series will be presented, supporting the notion that when a constant non-specific tinnitus percept is intermixed even intermittently with a forme fruste of one of these two types of pathognomonic tinnitus, detection of the pathognomonic component will point to the underlying cause of the constant non-specific percept, which in turn will lead to treatment that can abolish both percepts. 

For monaural non-specific tinnitus, if typewriter-like clicking is also present, then the etiology is auditory nerve distortion, which will then lead to specific treatment options.

For any kind of non-specific tinnitus, if sometimes there are pulsations that can be suppressed somatically, then the etiology is head or neck somatic myofascial dysfunction.

Biography:

Dr. Hua Ou received her medical degree at West China Center of Medical Sciences at Sichuan University, Sichuan, China and practiced as an otolaryngologist before she came to America ten years ago. She then received her Ph.D. in Hearing Science as well as a Master’s Degree in Biostatistics at the University of Iowa. She is an assistant professor and a biostatistician at Illinois State University. She has received multiple awards including ASHA career award and has published ten papers in reputed journals.  

Abstract:

ABSTRACT:

The Acceptable Noise Level (ANL) has received substantial attention due to its potential to predict hearing-aid use success. It is a subjective measure of patients’ willingness to tolerate noise, while listening to speech at the most comfortable level. Previous research suggests no relationship between ANLs and objective speech recognition performance in noise for hearing-impaired listeners. However, the relationship between self-rated speech intelligibility and ANL is unknown.

Forty-six hearing-impaired listeners and twenty normal-hearing listeners participated in the study. The ANLs were measured by Quick Speech-in-Noise (QuickSIN) test sentences in a four-talker babble. The self-rated speech intelligibility and the objective speech recognition performance were both measured, using the same test format and materials from the QuickSIN protocol. The differences between the rating of intelligibility and objective measures reflect how accurately listeners can judge their ability to listen in noise. Pearson correlation was used for the data analysis. The data revealed a significantly moderate correlation (r = 0.6, p < .0001) between ANLs and self-rated speech intelligibility for hearing-impaired listeners and a weak but significant correlation of 0.4 for the normal-hearing listeners (p = .04). No relationship was found between ANLs and the discrepancy of objective and subjective speech recognition performance for either group. The results indicated that listeners who rated themselves as highly able to listen to speech in noise were better able to tolerate noise than those who rated themselves as less able to listen in noise.

Biography:

Noman Shahzad is a General Surgery Resident at The Aga Khan University Hospital (AKUH) Pakistan. He has recently completed his licensure requirement to practice general surgery in Pakistan. He is also a Member of Royal College of Surgeons of England. He has keen interest in trauma surgery and critical care management and has published in this field.

Abstract:

Introduction: Though short term survival advantage of damage control laparotomy in management of critically ill trauma patients is established, there is little known about the long term quality of life of these patients. Facial closure rate after damage control laparotomy is reported to be 20-70%. Abdominal wall reconstruction in those who failed to achieve facial closure is challenging and can potentially affect quality of life of these patients.
Method: We conducted retrospective matched cohort study. Adult patients who underwent damage control laparotomy from January 2007 till June 2013 were identified through medical record. Patients who had concomitant disabling brain injury or limb injuries requiring amputation were excluded. Age, gender and presentation time matched non exposure group of patients who underwent
laparotomy for trauma but no damage control were identified for each damage control laparotomy patient. Quality of life assessment was done via telephonic interview at least one year after the operation, using Urdu version of EuroQol Group Quality of Life (QOL) questionnaire EQ5D after permission. Wilcoxon signed rank test was used to compare QOL scores and McNemar test was used to compare individual parameters of QOL questionnaire. Study was approved by institutional ethical review committee.
Results: Out of 32 patients who underwent damage control laparotomy during study period, 20 fulfilled the selection criteria for which 20 matched controls were selected. Median age of patients (IQ range) was 33 (26-40) years. Facial closure rate in damage control laparotomy group was 40% (8/20). One third of those who did not achieve facial closure (4/12) underwent abdominal wall
reconstruction. Self-reported QOL score of damage control laparotomy patients was significantly worse than non-damage control group (p=0.032). There was no statistically significant difference in two groups regarding individual QOL measures. Significantly more patients in damage control group were requiring use of abdominal binder and more patients in damage control group had to either change their job or had limitations in continuing previous job. Our study was not adequately powered to detect factors responsible for worse QOL in damage control group. Conclusion: Quality of life of damage control patients is worse than their age and gender matched patients who underwent trauma laparotomy but not damage control. Adequately powered studies need to be conducted to explore factors responsible for this finding for potential improvement.

Biography:

Ahmed Abdelhamid has completed his PhD at the age of 35 years from Ain Shams university and He is now assistant professor at University of Dammam, Suadi Arabia, He has published  more than 7 papers  in reputed journals.    
 

Abstract:

Study design This was a retrospective study that was conducted to assess pediatric dysphagia using FEES as a clinical diagnostic tool. Participants and methods The study included 64 children (38 male, 26 female). Of them, 32 patients were suffering from diffi culty in swallowing of different degrees and 32 were controls (they were not suffering from any diffi culty in swallowing). The mean age in months for symptomatic children was 41.47 ± 36.25 and the mean age in months for control cases was 42.08 ± 35.61. The examination was carried out using FEES applying the standard FEES protocol of Langmore (2001).

Results Application of the standard FEES protocol of Langmore (2001) showed highly related signs of pediatric dysphagia, such as handling of secretions, pharyngeal function in part I and timing of the bolus fl ow/initiation of the swallow, structural movements during the swallow, and residue after the swallow and between swallows in part II.

Conclusion and recommendation There are more common signs related to pediatric dysphagia than others and should be considered in any therapeutic program for overcoming dysphagia in children. Laryngomalacia is a structural disorder causing pediatric dysphagia in a considerable number of children. The standard FEES protocol should be applied on a larger number of pediatric populations with different disorders. 

Biography:

Juan C Gomez-Izquierdo is currently pursuing PhD in Experimental Surgery at McGill University. He has completed a Research Fellowship in Department of Anesthesia at the same university and obtaining Medical Residency training at Jewish General Hospital in Montreal. He has completed his Medical degree at Pontificia Universidad Javeriana. He has co-authored different papers in perioperative care and goal directed fluid therapy, including meta-analyses, randomized controlled trials, cohort studies and three book chapters. His area of interest includes epidemiology, evidence-based medicine and hospital care.

Abstract:

Goal directed fluid therapy (GDFT) optimizes oxygen delivery by guiding fluid administration using cardiac output analysis. It has demonstrated to enhance the bowel function and to decrease the incidence of postoperative primary ileus (PPOI) in some clinical trials. Bowel perfusion is critical for bowel motility; thus, an improvement of the splanchnic blood flow might explain the effects of GDFT on bowel function. Nowadays, it is feasible to evaluate tissue microcirculation at the patient’s bedside with side stream dark field (SDF) technology. A cohort of 24 patients undergoing colorectal surgery in an enhanced recovery program at the Montreal General Hospital and receiving either intraoperative GDFT (eight patients) or standard fluid therapy (16 patients) was followed and microcirculatory measurements were done using the MicroScan, MicroVision Medical at seven different perioperative time points. Bowel function and incidence of PPOI were assessed. PPOI was found in three patients in GDFT and three patients in the standard fluid therapy exposure (p=0.643). The overall perioperative proportion of perfused vessels (PPV) was higher in the GDFT exposure (p=0.023); and specifically on postoperative (POP) day three (p=0.032). There was no significant difference in other microcirculation outcomes. To conclude, GDFT improves the PPV, a key factor for oxygen extraction in the tissues, effect that was sustained until postoperative day three. GDFT also demonstrated a more stable oxygen delivery throughout the surgery. Nevertheless, these physiological effects did not translate into a better postoperative bowel function in GDFT compared to standard fluid therapy.

Biography:

Noman Shahzad is a General Surgery Resident at The Aga Khan University Hospital (AKUH) Pakistan. He has recently completed his licensure requirement to practice general surgery in Pakistan. He is also a Member of Royal College of Surgeons of England. He has keen interest in trauma surgery and critical care management and has published in this field.

Abstract:

Introduction: Though short term survival advantage of damage control laparotomy in management of critically ill trauma patients is established, there is little known about the long term quality of life of these patients. Facial closure rate after damage control laparotomy is reported to be 20-70%. Abdominal wall reconstruction in those who failed to achieve facial closure is challenging and can potentially affect quality of life of these patients.
Method: We conducted retrospective matched cohort study. Adult patients who underwent damage control laparotomy from January 2007 till June 2013 were identified through medical record. Patients who had concomitant disabling brain injury or limb injuries requiring amputation were excluded. Age, gender and presentation time matched non exposure group of patients who underwent
laparotomy for trauma but no damage control were identified for each damage control laparotomy patient. Quality of life assessment was done via telephonic interview at least one year after the operation, using Urdu version of EuroQol Group Quality of Life (QOL) questionnaire EQ5D after permission. Wilcoxon signed rank test was used to compare QOL scores and McNemar test was used to compare individual parameters of QOL questionnaire. Study was approved by institutional ethical review committee.
Results: Out of 32 patients who underwent damage control laparotomy during study period, 20 fulfilled the selection criteria for which 20 matched controls were selected. Median age of patients (IQ range) was 33 (26-40) years. Facial closure rate in damage control laparotomy group was 40% (8/20). One third of those who did not achieve facial closure (4/12) underwent abdominal wall reconstruction. Self-reported QOL score of damage control laparotomy patients was significantly worse than non-damage control group (p=0.032). There was no statistically significant difference in two groups regarding individual QOL measures. Significantly more patients in damage control group were requiring use of abdominal binder and more patients in damage control group had to either change their job or had limitations in continuing previous job. Our study was not adequately powered to detect factors responsible for worse QOL in damage control group. Conclusion: Quality of life of damage control patients is worse than their age and gender matched patients who underwent trauma laparotomy but not damage control. Adequately powered studies need to be conducted to explore factors responsible for this finding for potential improvement.

Biography:

Sherin A Khalam is an Associate Professor at PMS College of Dental Science and Research, India. He is the Surgical Head of the Department of Dental and Maxillofacial Surgery, SUT Royal Hospital, Director of Khalams Medical Centre and a Fellow of International Congress of Oral Implantologists, USA. He has completed his BDS from Vinayaka Missions University, MDS from Annamalai University and MSc in Clinical Psychology from Tamil Nadu University. He has more than 50 international publications to his credit. He has completed advanced training in Implantology from Lleida, Barcelona, Spain and was course Coordinator at University of Genova, Italy.

Abstract:

Aim: The aim of our study was to evaluate the effect of coronoidectomy with excision of fibrotic bands as an operative technique in management of oral submucous fibrosis.
Materials & Methods: A patient with histologically proven lesions of category group IV A (severe trismus with an interincisal distance of less than 15 mm and extensive fibrosis of all the oral mucosa) case of oral submucous fibrosis, having a mouth opening of 12 mm was surgically treated. The procedure involved bilateral release of fibrotic bands, bilateral coronoidectomy and no reconstruction covering the buccal defects with collagen membrane. Regular physiotherapy and follow up were done and results were assessed by comparing the preoperative and postoperative mean intraoperative inter incisal distance.
Results: The intraoperative inter incisal distance after band excision and coronoidectomy increased up to 38.0 mm. The mean mouth opening after one year follow up was found to be 39.6 mm. Conclusion: In management of oral submucous fibrosis, the procedure of coronoidectomy after fibrotic band release had excellent results with adequate mouth opening and no recurrence was noticed until the last follow up.

Biography:

Alessandro Bucci is a Reserve Medical Officer of Italian Navy. He has Fellowship experienced in Otolaryngology at University Hospital, Cadiz, Spain. He was a Consultant in Otolaryngology. He has Fellowship in Facial Plastic Surgery (AMC) and OSAS at Sint Lucas Andreas Hospital, Amsterdam, Netherlands and in Facial Plastic Surgery at C. Garcia University Hospital, Cuba. He is a dedicated ENT Specialist Surgeon with 14 years of experience providing the highest standard of treatment. His research focused on rhinology/rhinoallergology, OSAS and dysphagia.

Abstract:

The aim of this study was to identify patterns of airway collapse and sites of obstruction during drug induced sleep endoscopy (DISE) as predictors of surgical failure following multilevel airway surgery or just somnoplasty for patients with obstructive sleep apnea syndrome (OSAS). A systematic review was performed of studies using DISE to identify sites and patterns of obstruction in patients with OSAS. Medical records of all adult patients undergoing diagnostic DISE at our Centre for Diagnosis and Treatment
of Respiratory Sleep Disorders as part of their surgical evaluation were reviewed. For each patient, we recorded obstruction sites, obstruction patterns and the effects of the mandibular pull-up manoeuvre on both obstruction and snoring. We compared the results of clinical and diagnostic evaluation with those of sleep endoscopy. According to other authors, considering a complete obstruction of 100%, we found that palatal obstruction was the most frequently observed site of obstruction, followed by tongue base obstruction,
laryngeal obstruction and hypopharyngeal obstruction. DISE is mandatory in the diagnostic work-up of OSA and is a valid addition when surgery is considered. DISE is a dynamic, safe and easy-to-perform technique that visualizes the anatomical sites of snoring or apneas and guides the design of a tailor-made treatment plan in individual cases improving the qualitative and quantitative results of treatment. Understanding the sites of collapse is mandatory for surgical treatment decision-making in obstructive sleep-apneahypopnea syndrome patients. Moreover, it could help prevent unrealistic expectations regarding the available treatment for each patient

Biography:

Antje-Christin Deppe earned  her medical degree at the age of 27 years from Heinrich-Heine University od Düsseldorf and finished postdoctoral studies 2010. She finised cardiothoracic residency and is now the head of the cardiothoracic intensive care unit at the department of cardiothoracic surgery at university hospital of colgne.

Abstract: